Treatments for Toenail Fungus

The best way to start treating your toenail fungus is to have an appointment with your doctor so that you can receive proper diagnosis.  Other nail conditions can look similar to fungus, such as post-injury changes to the nail plate, so often your physician will take samples of the nail to be evaluated prior to recommending therapy.

There are several over-the-counter (OTC) ointments and medications that you can try to treat your toenail fungus. Your doctor can also prescribe oral and topical prescription medications.  Surgery to remove the nail and Laser treatments are also available. The goal of most of these treatment options is to attempt to kill the fungus and allow the uninfected nail to grow out. It takes approximately 10 to 12 months for toenails to grow out.  The choice of treatment modality will vary considerably depending on severity and extent of the disease, coexisting medical conditions, patient medications, physician and patient preference.

OTC (Over-the- Counter medication)

Tea tree Oil and Miconazole Nitrate cream/gel. The over the counter Miconazole Nitrate is usually mixed with ingredients like Alcohol, Cocamide, Benzyl Alcohol, Tocophenol, Isobutane, and Propane and Sorbitan Sesquioleate. Once it is mixed with the ingredients it becomes a good anti-fungal solution for mild and preventive treatment for fungus.

Anecdotally, home remedies such as daily application of Listerine or Vicks Vapo-Rub are thought to help to kill nail fungus.  You may also hear about soaking your nails in vinegar.  While there are no large scientific studies which prove that these methods work, they pose little, if any, risk, and I do not have a problem with patients trying them.

Prescription: Topical medications and oral medication

Topical Medications

The advantage of topical therapy is that it allows for direct application to the affected area and reduces the chance of adverse systemic drug reactions. Prescription topical medication is great choice for the patients with mild- to moderate fungal disease, those with hepatic or hematologic disorders that may put them at risk with systemic medication usage, and for those unwilling to take systemic medication.

  • Penlac:  The only topical medicine approved for use in the United States. Penlac needs to be applied to the surface of the entire nail and the surrounding skin daily. Once a week, it is removed with rubbing alcohol along with debris and unattached nail.
  • Naftin, Lamisil, and Loprox creams may also be used for onychomycosis. There have only been small studies done using these.  They are typically prescribed for fungal infections on the skin.
  • Formula 3:  Antifungal cream+ Urea Cream
  • Urea Cream: The use of urea cream may help dissolve the toenail and any topical medication penetrate the nail.

Oral Medication

The oral antifungal medications offer the advantage of a high efficacy rate and short-course therapy. However, not everybody is a candidate for oral therapy.  It is important to select the patient wisely, as some of these medications pose a risk to your liver or kidneys.  Simple blood tests are routinely done first to rule out any underlying health problems.

  • Terbenafine (Lamisil): This medication has an efficacy rate of 70-80%, and has been proven to kill most of the fungal organisms that infect nails. It is taken daily for 12 weeks.  It carries the risk of liver toxicity.
  • Itraconazole (Sporonox): This medication works by inhibiting the growth of fungus.  It is less commonly used today and also poses a risk to your liver.
  • Fluconazole has also been used to treat onychomycosis. It only needs to be taken once a week, for a total of 3 months for fingernails or 6 months for toenails. It does not work as well as terbinafine or itraconazole, but is processed primarily by your kidneys, so carries less risk for liver side effects.

Laser Treatment/Surgery

Laser therapy is a relatively new option for treating toenail fungus.  It is safe and fast, and initial studies show a high success rate.  Laser treatment for toenails is not covered by insurance, and with a total cost of up to several thousand dollars, it becomes cost-prohibitive to many patients.  Only a few physician nationwide are offering laser in their office.  Time will tell whether this will become more mainstream and affordable in the future.